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Recurrent audiovestibular dysfunction and associated neurological immune‐related adverse events in a melanoma patient treated with nivolumab and ipilimumab
Author(s) -
Choi Jonathan S.,
Chen Merry,
McQuade Jennifer L.,
Appelbaum Eric,
Gidley Paul W.,
Nader MarcElie
Publication year - 2020
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.26455
Subject(s) - medicine , ipilimumab , nivolumab , adverse effect , ototoxicity , discontinuation , hearing loss , audiogram , immunotherapy , chemotherapy , audiology , cancer , cisplatin
Background Recurrent immunotherapy‐induced audiovestibular toxicity despite cessation of therapy has not been reported. Methods We report the first case of recurrent audiovestibular toxicity following immune‐checkpoint inhibitor (ICI) therapy. The patient was seen with sudden bilateral hearing loss and disequilibrium. After ruling out other etiologies, he was diagnosed with audiovestibular and neurological immune‐related adverse events (irAEs). He received systemic steroids, with significant hearing and balance recovery. Over the following 4 months, he experienced two other episodes of sudden bilateral hearing loss despite ICIs cessation. The second episode was treated with oral steroids, and hearing improved. On the third episode, he received oral and intratympanic steroids, and he was started on infliximab. Results Audiogram 8 months following the last recurrence showed hearing improvement and stability. Conclusion Immunotherapy‐induced ototoxicity may recur despite therapy cessation. High dose steroids remain the mainstay of treatment. If audiovestibular irAEs recur despite multiple courses of steroids, immunosuppressive agents may be considered.